Treatment of Malignant Rectovaginal Fistula

Introduction to Malignant Rectovaginal Fistula Treatment

• For malignant rectovaginal fistulas, surgical resection with oncologic principles is the definitive treatment when curative intent is possible, while fecal diversion provides palliation for patients who cannot undergo resection 1

Critical Distinction: Malignant vs. Inflammatory Fistulas

• Medical therapy with anti-TNF agents has no role in malignant fistulas and should not delay definitive oncologic treatment, as recommended by the American Gastroenterological Association 2

Curative Treatment Approach

• Oncologic resection is the cornerstone of curative treatment for malignant rectovaginal fistulas, with a high success rate, according to the American Society of Colon and Rectal Surgeons 1

Critical Pitfalls to Avoid

• Never attempt local repair procedures (advancement flaps, sphincteroplasty) for malignant fistulas, as these are contraindicated and will fail, as stated by the American Gastroenterological Association 2